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Meridian Enhanced Benefits & Limits
Coverage Area Area 1 - Including the US and Canada
Area 2 - Excluding the US and Canada
Overall Policy Maximum $5,000,000 Lifetime
Deductibles Available $250, $500, $1,000, $2,500 or $5,000 per Member per Certificate Period.
Family Deductible Maximum of 3 Deductibles per family per Certificate Period
Coinsurance
(Claims incurred in US or Canada)
After the Deductible the Plan will pay 90% of the next $5,000 of Eligible Expenses, then 100% to the Overall Maximum Limit. The Coinsurance will be waived if expenses are incurred within the PPO.
Coinsurance
(Claims incurred outside US or Canada)
After the Deductible the Plan will pay 100% of Eligible Expenses to the Overall Maximum Limit
Pre-certification Penalty 50%
Pre-existing Condition Same As Any Other Injury or Illness if fully disclosed on Application and not excluded or limited by a Rider (after 12 months of continuous coverage)
Maternity
(Normal or Complicated Delivery)
Same As Any Other Illness; $5,000 additional Deductible, $100,000 Maximum Limit (after 12 months of continuous coverage)
Newborn Care Included as part of Maternity benefits for maximum of 60 days.
Human Organ/Tissue Transplants $2,000,000 Maximum Limit
Hospital Room and Board Usual, Reasonable and Customary (URC)
Intensive Care Unit Usual, Reasonable and Customary (URC)
Emergency Room Usual, Reasonable and Customary for covered Illness if hospitalized as Inpatient and for covered Injuries
Local Ambulance Usual, Reasonable and Customary (URC)
Surgery Usual, Reasonable and Customary (URC)
Prescription Medications Usual, Reasonable and Customary (URC)
Subject to deductible and coinsurance
Vision Care $100 Maximum Limit per Coverage Period for exams and materials (after 12 months of continuous coverage).
Dental Coverage
(Optional Rider)
$750 Maximum per Calendar Year. $50 Individual Deductible. Schedule of Benefit payout: Class A=90%; Class B=$70%; Class C=$50%; Ortho= no coverage (6 month waiting period). Including Emergency Dental, subject to the overall Maximum Limit, and (after 6 month waiting period).
Mental & Nervous Disorders $50 per visit, per day for outpatient care. $15,000 per Coverage Period (after 12 months continuous coverage). $30,000 Maximum Limit.
Physical Therapy $50 Maximum per visit.
Wellness (Adult) $250 per Male age 25 and over/Woman age 30 and over, per Coverage Period (after 12 months continuous coverage). Not subject to Deductible or Coinsurance.
Wellness (Child) $150 per Member age 18 and under, per Coverage Period (after 10 months continuous coverage). Not subject to Deductible or Coinsurance.
Complementary Medicine $175 Acupuncture; $175 Aroma Therapy; $175 Herbal Therapy; $175 Massage Therapy; $175 Vitamin Therapy (after 12 months of continuous coverage); per Coverage Period. Maximum Limit of one service per Coverage Period.
High School Sports Injury $7,000 Maximum Limit (subject to an additional $250 deductible) for medical benefits only.
All Other Eligible Expenses Usual, Reasonable and Customary (URC)
Emergency Room Illness Usual, Reasonable and Customary (subject to additional $250 Deductible if not admitted)
Emergency Room Accident Usual, Reasonable, and Customary (URC)
Emergency Medical Evacuation $110,000 Maximum Limit, $55,000 Maximum Limit for ages 60 and older.
Repatriation of Mortal Remains $30,000 Maximum Limit per Member (not subject to Deductible)
Emergency Reunion $10,000 Lifetime Maximum.
With regard to the foregoing Schedule of Benefits/Limits, the references to "continuous coverage" mean continuous unbroken coverage under the Beacon/Axis Series Group Insurance Trust (Anguilla). The applicable benefits described will become first available to the Participating Member only at the end of the continuous Coverage Period so specified.